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Learn How to File Unlisted Procedure Codes (NDCs) Electronically

Are You Billing Unlisted Procedure Codes for Drugs and Injections on Paper Claims?

Are you interested in filing your unlisted procedure codes for drugs and injections electronically, but unsure how? Providers often file unlisted procedure codes on paper claims in order to include the descriptions of the services rendered. The electronic format system for filing claims includes a descriptive field for each line of service, allowing providers to include the description of services rendered. This helps reduce the unnecessary filing of paper claims.

Listed below is the information needed to include the description of services rendered when billing an unlisted procedure code (NDC number).

The NDC number is sent on an electronic ANSI 837 ANSI (4010A1) in the LIN segment of the 2410 Loop. The LIN 02 houses the qualifier and the LIN03 houses the actual descriptive field. The 2410 Loop is a situational loop that may not always appear on the electronic 837 claim file. The loop is included only if the billing party has to report drug information.

Procedures for Not-Otherwise-Classified Drug Codes

In the past, services for Not-Otherwise-Classified (NOC) "J Codes" required narrative descriptions and/or submission using paper claims. The fields below provide the additional information required by the Blue Cross and Blue Shield of Oklahoma adjudication system to process these services electronically. The addition of these fields will expedite processing and ensure accuracy. The following table defines the new fields and the location of the elements in the professional electronic claim format.

Field Name

Field Description

ANSI (Loop 2410)Ref Desc

NDC UNITS

National Drug Code UnitsThis field identifies the number of units administered of the prescription drug.

CTP04

NDC UNIT OF MEASURE

National Drug Code Unit of MeasureThis field identifies the unit of measure of the drug administered. Values:F2 — international unitGR — gramML — milliliterUN — unit

CTP05-I

NATIONAL DRUG CODE

National Drug CodeNational code assigned to the drug administered.

LIN02 = "N4"LIN03 = the NDC code

NDC UNIT PRICE

Unit PricePrice per unit of measure for the administered drug.

CTP03

Modifications to provider billing systems or notification to billing vendors to make the above changes may be required. Please contact your software vendor to ensure your software will support these data elements. If you have any questions, please contact the Availity Client Services at 1-800-AVAILITY.